Using a Prompt Sheet to Improve the Reference Interview in a Health Telephone Helpline Service

Toni Price, Christine Urquhart

Abstract


Objective - The study examined whether a prompt sheet improved the reference interview process for health information advisers working at NHS Direct, a 24 hour telephone helpline that provides confidential health care advice for the public in England.


Method - A randomised control trial was conducted at eight NHS Direct sites across England in 2003-04. Newly recruited health information advisers (n=30), full and part-time, were randomly allocated to a control group (n=15) or intervention group (n=15), and 26 completed the study. Existing health information advisers were involved in the planning and design of the intervention. The prompt sheet included prompts for demographic information, reason for call, condition/treatment plan, existing knowledge of caller, special needs of the caller, handling a call empathetically, conclusion. Testing of reference interview expertise was done at the end of basic training, and two months later, using the same ten test questions, that were based on common questions received by NHS Direct. A relevance framework for possible responses was drawn up for each question for scoring test responses, with more relevant responses scoring higher than less relevant responses.

Results - The average score of prompt (experimental) and non-prompt (control) participants increased on the second test, for each of the 10 questions. The prompt group improved significantly more overall than the control group. There was variation within the groups. Sixteen health information assistants showed a net increase in their score over all ten questions (10 experimental group, six control group). The post-test score for an individual on a particular question did sometimes decrease from the pre-test score, but all 26 improved on at least one question. Previous call handler experience did not appear to influence the extent of improvement, but length and type of experience in the post may have an influence.

Conclusion - The trial demonstrated the benefit of a simple and inexpensive prompt sheet for some, though not all, newly recruited health information advisers to improve their reference interview technique.


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